Introduction 1 3 4 9 5 6 8 10 12 5 6 8 13 14 15 19 12 20 21 5 7 22 11 22 25 The aim of this study was to (1) analyse the prevalence of depressive symptoms and urinary symptoms during and after pregnancy and (2) assess the association of urinary symptoms with depressive symptoms, controlling for psychosocial, behavioural, socioeconomic and biomedical factors during and after pregnancy. Materials and methods Study population Between January 2002 and July 2003, 1,366 nulliparous pregnant women from 10 urban midwifery practices in the center of The Netherlands were approached to take part in a prospective longitudinal cohort study assessing pelvic floor problems, sexuality and back pain during first pregnancy until 1 year after delivery. All nulliparous pregnant women received information about the study from the midwives. After 1 week, the women were approached by phone and asked if they wanted to participate in the study. Inclusion criteria were a singleton low risk pregnancy and sufficient knowledge of the Dutch language. n n Data collection 26 27 28 29 30 31 32 33 2 Statistical analyses t p p Results 2 2 1 p 2 p R 2 Table 1 Incidence of depressive symptoms (CES-D ≥ 16), incontinence and over-active bladder syndrome   12 weeks gestation (%) 36 weeks gestation (%) 3 months post-partum (%) 12 months post-partum (%) Depressive symptoms 18.2 20.7 16.7 12.2 Urge incontinence 7.3 19.1 16.1 15.6 Stress incontinence 20.1 42.2 26.5 34.3 Over-active bladder syndrome 54.2 60.1 7.8 14.4 Table 2 Univariate and multivariate associated factors with depressive symptoms at 36 weeks gestation   n n Crude OR (95% CI) Adjusted OR (95% CI) UDI Urge incontinence 17.4% 26.7% 1.73 (1.05–2.86)  Stress incontinence 39.2% 52.4% 1.71 (1.11–2.63)  Over-active bladder syndrome 57.0% 73.3% 2.08 (1.29–3.34) 4.40 (1.84–10.48) MMQ Emotionality 6.62 (6.21) 13.74 (11.33) 1.10 (1.07–1.13)  Sexuality 11.52 (6.95) 16.53 (8.12) 1.09 (1.06–1.13) 1.12 (1.06–1.17) NPV Inadequacy 8.08 (5.09) 14.50 (7.79) 1.17 (1.13–1.22) 1.21 (1.13–1.30) Social inadequacy 6.89 (6.19) 9.84 (6.96) 1.07 (1.04–1.10) 1.08 (1.01–1.16) Rigidity 24.65 (6.81) 26.47 (5.91) 1.04 (1.01–1.08)  Hostility 12.36 (5.36) 17.12 (6.71) 1.14 (1.10–1.19)  Egoism 9.03 (4.23) 10.56 (4.90) 1.08 (1.03–1.13)  Self-esteem 30.30 (4.83) 27.09 (4.56) 0.88 (0.84–0.92)  2 27.59 (3.65) 29.22 (5.24) 1.10 (1.04–1.15)  Age (years) 30.50 (3.67) 29.66 (4.02) 0.94 (0.89–1.00)  Education high school/below 46.9% 63.2% 1.95 (1.25–3.02)  Unemployed 4.5% 12.3% 3.00 (1.42–6.34)  Low job satisfaction 5.2% 15.1% 3.23 (1.57–6.68)  Smoking 7.1% 16.2% 2.53 (1.33–4.83)  Use of alcohol 16.0% 6.7% 0.38 (0.17–0.85)  No leisure time physical activity 43.2% 65.1% 2.46 (1.57–3.83) 2.83 (1.35–5.92) Back pain 51.9% 67.0% 1.90 (1.21–2.98)  Pregnancy related complications 8.8% 20.8% 2.71 (1.38–5.34) 3.22 (1.12–8.87) p CES-D UDI MMQ DPQ BMI OR 95% CI Discussion p 15 19 34 15 35 36 37 In a pregnant population, several other explanations can be considered. First, during the third trimester of pregnancy, the increase in cardiac output, increasing size of the uterus with compression of the bladder and sleep disturbances may all contribute to an increased voiding frequency. Secondly, the definition used for over-active bladder syndrome (combination of urgency and frequency) has been developed for use in a non-pregnant population. Because the majority of women will have frequency and urgency symptoms as part of their normal third trimester pregnancy, it is questionable if the diagnosis of OAB in pregnancy has the same meaning and impact as OAB in non-pregnant women. The strength of this study is that we used a prospective, longitudinal design with validated questionnaires in a large number of healthy nulliparous women. By measuring not only urogenital symptoms and depressive symptoms, but also psychosocial, behavioural, socioeconomic and biomedical factors, we were able to perform solid multivariate analysis techniques on the associations between bladder symptoms and depression. 31 38 39 13 40 41 7 5 7 21 22 42 45 46 Conclusion We found significantly higher rates of depressive symptoms, SUI and OAB syndrome during pregnancy than after childbirth. After controlling for other associated factors, we found an independent association between depressive symptoms and the OAB syndrome in pregnancy but not with urinary incontinence. This association between OAB syndrome and depressive symptoms is lost after pregnancy, so it is likely that pregnancy-related factors have confounded this association. In general practice, this information on the natural course of the OAB syndrome, and its lack in causing major depressive symptoms after childbirth, can be used to counsel women who are confronted with these problems during pregnancy.